By George Bischalaney, President & CEO, Eden Medical Center
Health care reform is on the agenda, again. The stakes are high, but our President is determined to make some significant changes. As the discussion moves from general to specifics, special interests are staking out their positions. None of the stakeholders—hospitals included—wants to feel the impact or be at a disadvantage.
Amidst the demand for cost reduction and health care coverage for all, there is and must be continued investment in care. Physicians demand it. They expect to be able to practice with state-of-the-art equipment and facilities to produce outcomes that meet national, state and local quality standards. Patients demand it. They want to know that their local hospital has the right number of well-trained staff as well as the latest diagnostic and treatment equipment, and contemporary facilities.
With this backdrop of conflicting needs, Eden Medical Center is about to begin a three-year project that will result in the replacement of the Castro Valley hospital. The project cost is estimated to be $320 million. The current 55-year-old building is anything but contemporary. With few private rooms, small operating rooms and inadequate support space for clinical services, a new hospital is very much needed.
Eden Medical Center has served the community well, but it was not designed for patient comfort and needs, more for staff needs and functionality. While our project may seem ill timed given the uncertainty of hospital reimbursement, we are required to meet California legislated standards for seismic safety in hospitals. And it truly is needed.
We’ll celebrate our long sought goal with a ground-breaking ceremony on July 1st. Then we’ll spend the next three years continuing the investment in the new buildings and equipment, while observing and hoping that decision makers do not enact legislation that essentially penalizes us for the commitment we are making. When we celebrate the grand opening and our new beginning early in 2013, it should be with the same hope and dreams as those who celebrated the first ceremony in 1954.
By Digby Christian, Project Team Leader
FIATECH is an industry consortium within the building industry. Its primary mission is to get all the “players” involved in capital projects to adopt new ways of thinking and new technologies to deliver higher value for the funders and end-users of construction projects.
Here is why our team won the award…
As most of our readers know, California’s deadline for retrofitting or building earthquake-proof hospitals from scratch is 2013, less than four years from now. The hospital project in its current form was validated as viable in August 2007, and design work was authorized to start in October of that year, leaving us just over five years to have the building be ready and open for business. Typically, in California, it takes at least seven years for a project of this magnitude.
So the team had to throw out all historical concepts of how design is done and come together as a wide-ranging, multi-company team involving the owner, the designers and the builders, and transform the design and construction process to drive two years out of the schedule. The team is now on track to achieve just that and did it primarily by redesigning the design process in a rigorous and unrelenting fashion, so that it no longer bears any real resemblance to tradition!
If you are familiar with the classic design process, you’ll know that it’s typically abbreviated as “SD-DD-CD”: Schematic Design (broad concepts typically discussed and agreed to by the owner and the architect exclusively); Design Development (often a General Contractor might have some involvement in this); and Construction Drawings (some trades might be brought on board to inform how these are put together). Then, the work goes out to the building community and those companies develop what are known as Shop Drawings. These drawings show in detail how every little and large item in the building will be fabricated, i.e., the structural elements, including steel, metal, glass, concrete, etc.
On the SMCCV project, all of the people who typically are brought in at the end are already on board, and most of them have been on board since August 2007. By the time this project completes its approval process through the County and State we will already be at the Shop Drawing stage. The building is being designed for fabrication now, while the design approval process is underway.
While this concept has been discussed for the last few years within the industry, and parts of the above have been implemented on other projects, no project has implemented this concept as broadly and as deeply as the SMCCV project; certainly not on a project this large and this complex. It is one of the reasons our project won the FIATECH award!
The other primary reason we won the award is because of how thoroughly the building has been designed in three dimensions (as opposed to the typical two dimensional paper drawings we are used to seeing). There are many very attractive shots of 3D design that you can find on websites, and in trade magazines but you can’t tell if the designs are any good—all you know is they look “cool.” But on the SMCCV project, we bring the entire team together at least every two weeks to work through the coordination effort. It’s painstaking and difficult, but utterly critical to a successful outcome in a shorter timeframe.
What is not often understood outside the industry, and to some extent even within the industry, is that different design disciplines use different software, and they can’t see each other’s work in real time while they are designing. Each company has to either import a converted file of each other’s work or send both files to a third package, such as Autodesk Navisworks, to see both designs at the same time. So it’s all too easy to have a poorly coordinated, unbuildable, three dimensional design—no different in fact than having a poorly coordinated, unbuildable, two dimensional design.
In addition, we have focused the team on the larger goal of designing for fabrication rather than the industry convention of designing to produce the construction documentation, which is then coordinated by the construction team. The team’s goal to design for fabrication means we are swimming against the tide. We are allowing our companies to each use their own best-in-class software and then developing a process that allows a high level of coordination and constructability to ensure that what is being designed is actually what we will build.
The above might seem dry and technical; however, by a) having a multi-company team involving all the construction trades from day one; b) throwing out the baggage of a poor design process and starting from scratch to build a better one; and c) having a goal of designing for fabrication will allow us to build a new hospital on schedule, within budget, and without any last minute compromises on the finished product.
On the Sutter Medical Center Castro Valley project, we are breaking new ground ahead of any other project in the country in the way such projects are handled. That, in essence is the reason why the team that is building your hospital won the 2008 FIATECH CETI Award.
In addition to the Sutter Health project team, I want to personally thank The Devenney Group, DPR Construction, Capital Engineering, The Engineering Enterprise, TMAD Taylor & Gaines, GHAFARI Associates, J W McClenahan, Morrow Meadows, Superior Air Handling, MPS Project Management, Navigant Consulting, Greenwood & Moore Engineering, Herrick Steel, Otis Elevators, Strategic Project Solutions, Royal Glass, Clark Pacific, Candela, Sparling, and numerous other specialty trade vendors for making it possible to receive this award—and to meet our 2013 deadline!
For all you construction buffs, or for anyone who is interested, check out FIATECH at http://www.fiatech.org/.
I welcome your questions and comments!
By Todd Peterson, Vice President of Information Technology, Eden Medical Center
My name is Todd Peterson and I’m Vice President of Information Technology at Eden Medical Center. Castro Valley has been my home for the past 26 years, and I’ve worked for Sutter Health for ten years, joining Eden 2 ½ years ago.
My team is responsible for making sure all computer systems are up and fully functioning 24/7; and while computer repair is a significant part of our business, we are responsible for implementing new technologies that are now vital to many aspects of our patients’ care.
One major project underway that will be a cornerstone of the new Sutter Medical Center Castro Valley hospital is Electronic Health Records (EHR), a project conceived when I was still at Sutter. Basically the new hospital is being designed with minimal use of paper. That’s right… no more clipboards and illegible handwriting.
The EHR will facilitate all clinical documentation and reporting; all medical disciplines will be recorded. What does this mean? Our physicians will get a full view of a patient’s care at any given time, from any location, once their patient has been admitted to the hospital. So the patient’s medical history as it relates to diagnostics, drug therapy, procedures, diet, rehabilitation and notes generated by physicians and nurses will all be available online. This also includes previous visits to any Sutter Health-owned facility or physician office.
The EHR will ultimately be integrated with biomedical technology. That means much of the clinical equipment in patient rooms—heart monitors, blood pressure cuffs, IV pumps, and even the beds themselves—will feed information directly into the patient records. With real time monitors of the patient’s vitals, a physician can be alerted if a trend in their medical condition warrants medical attention well before a critical threshold is met. So the EHR will be a documentation system and much more; it will provide clinicians with a wider view of what is happening with a patient at all times so they can quickly take action.
Patient records will also show a correlation of clinical events, a true cause and effect. For example, a physician may order medications in response to laboratory test results. Subsequent laboratory tests can then be correlated to the timing of the medication and will demonstrate the degree of effectiveness. This constant correlation gives the entire care team the information they need to deliver the best care at the right time.
The critical exchange between the doctor who is on call and the nurse on duty will also be enhanced by EHR. Without delay, a physician can access the patient’s record from home, while the nurse views the same information from a workstation in the patient’s room so rather than just rely on a verbal exchange they are both viewing the patient’s record.
One of the key benefits of EHR is patient safety. In the area of medication management, physicians will use computerized order entry to address legibility issues and alert the physician to any contra indications, such as allergies, food or other medications that the patient is on. The process of administering the drug involves the nurse scanning the barcodes on the patient’s wristband and medication bottles. The system will confirm the patient’s name, medication name, correct time, correct dose and proper route (oral, or otherwise).
We will provide full accessibility to patient data. All this information, all images, reports, etc. will be available at the patient’s bedside. Every patient room, alcoves between rooms and nurses’ station will be furnished with a computer workstation so patient records can be accessed throughout the hospital. Physicians will also have wireless devices such as PC tablets to provide the most flexibility and mobility throughout the hospital.
Down the road, our patients who see Sutter Health physicians will be able to see their own clinical results online; they’ll be able to email their doctors and arrange appointments, and more importantly, track their own history and take responsibility for their own health. We may even use EHR to work in concert with our county and state health departments to track health trends in the community.
The prospects for EHR are endless. Our patients and clinicians become real partners in the delivery of care over the long term.
Your input is very important to us. I invite you to ask me any questions about the EHR system by either commenting beneath this post (click on the title of the post, if you are on the blog’s front page, and you’ll see the comment box below), or by emailing me.
Sidney Wanetick, M.D.
My name is Sidney Wanetick. For 26 years, I was in practice as an OB-GYN in Castro Valley, and I delivered more than 3,000 babies at Eden Medical Center.
In 2008, I retired from practice to accept the position of Vice President of Medical Affairs at Eden Medical Center. Today, I serve as the administrative liaison between the medical staff and administration, helping to support our physicians as they provide high quality care to our patients now and as we look to the future of Eden.
In addition to other duties, I am actively involved in assisting our physicians in recruiting new physicians to the community.
I’m very excited about the new Sutter Health hospital that is replacing Eden. Several major benefits stand out. In particular, having all private rooms for patients will make a huge difference, bringing more services to their bedsides and giving them more quality time with their doctors.
From the physician’s standpoint, this is a much better way to take care of patients and have important conversations with family members in private, as well as offer patients the privacy and rest needed for recuperation. The nurses’ stations will have a view of every patient’s room for faster response to patient needs.
The whole atmosphere of the new hospital will feel less institutional and more supportive, soothing and restful.
Today, even though Eden has 176 beds, we are unable to utilize all of these beds. Most rooms are semi-private, with very few private rooms and even a few four-bed wards. Yet, we can’t put men and women together, and we can’t mix patients with infections in with the general patient population. So even though Eden is larger, the Sutter replacement hospital will end up with a much better capacity for utilization of services.
Moreover, we are seeing a steady decline in the number of patients admitted to the hospital for more extended periods of time. When I first started my practice we admitted twice as many patients for surgery as we do today. My patients stayed in the hospital for five days or more! Also, if patients were scheduled for surgery, they would be admitted the night before. Today patients often have surgery and are discharged the same day, or, if they are admitted, the average length of stay is much shorter.
In addition to the 130 acute care beds, we’ll have a 34-bed, multi-purpose Universal Care Unit (UCU), which also supports the shorter hospital stay. Let’s say an Emergency Room patient has been treated and needs to stay for observation, but not necessarily be admitted. He or she can rest comfortably in the UCU. Or, if a patient is recovering from same-day surgery, we could have him assigned to a UCU bed where he’ll get the attention he needs.
There will also be vast improvements in our information technology systems that just aren’t possible at Eden; our current system has reached capacity. With the new electronic medical records system, our clinical staff will have access to lab reports, x-rays, medication, etc., right at their fingertips. Recent studies have demonstrated improved outcomes and fewer errors in centers that have electronic records, and the new hospital will have innovative, secure electronic records and data systems.
I welcome your comments and questions. Please feel free to leave a comment by clicking on the title of this post (if you are on the front page of the blog), and a comment box will appear below.
By George Bischalaney, President & CEO, Eden Medical Center
Yesterday, one of Eden Medical Center’s neurosurgeons, Dr. Dickinson blogged about what’s in store for neuroscience at the new Sutter Castro Valley hospital. Coincidentally, Eden was also mentioned in an article in the AARP Bulletin on February 2, which it picked up from the Contra Costa Times.
The article basically said that the State of California through its Office of Statewide Health Planning and Development (OSHPD) had released statewide data on “hospital death rates.” This data has been collected for some time and the most recent release includes data for 2007.
Eden was identified as having a “Better-Than-Average” rating for patients who undergo craniotomies, which is a procedure for removing brain tumors. The statewide average was 6.7%, while the rate at Eden was measured at 0.7%. We were one of 25 hospitals, among 400 hospitals statewide, with better than average results, and one of only three in the Bay Area. These results do not come about by accident or good fortune.
Eden has been a designated trauma center in Alameda County for over 20 years. The experience and training of our trauma center staff has helped strengthen the services we offer in surgery, critical care, diagnostics, rehabilitation and general medical care. The methods used by the trauma center surgical team have carried over to every patient treated at Eden.
Building upon the trauma center’s effectiveness and with the support of Sutter Health, Eden established the Sutter East Bay Neuroscience Center several years ago. One of the mainstays of these programs is neurosurgery (brain surgery). Eden is blessed with a core of very highly regarded and skilled neurosurgeons as part of its medical community. It is because of their expertise and our joint commitment to excellence in neurosciences that we have been able to have such outstanding results with this critically ill patient population.
OSHPD has a website with a link to all of the recently released data (go to www.oshpd.ca.gov and click on AHRQ). OSHPD points out that this data is risk adjusted, to ensure that all hospitals are treated fairly and that evidence suggests that high mortality may be associated with deficiencies in the quality of hospital care provided.
Public reporting of hospital data will become more common, and its use by consumers greater over time so that they can be better armed when making important decisions about where to seek their health care services.
By Bryan Daylor, Vice President of Ancillary and Support Services at Eden Medical Center
Technology is critical to convenience & efficiency…
As I mentioned in my previous post, our collaborative team has been very focused on how we would use technology, innovation and design to improve work flow and increase efficiency. You may also want to read the previous post by Andrew Flanigan, Senior Planner/Designer with Devenney Group, the architecture firm for Sutter Medical Center Castro Valley.
For example, in our clinical lab today, we have clinical space that is not fully utilized. The lab was originally designed when equipment was much larger and therefore required more space. The current lab was designed as a “decentralized” service, meaning that different sections of the lab, i.e., blood bank, hematology, chemistry, microbiology, pathology were divided into separate areas. We have learned over the years that this concept is outdated, as well as inefficient to operate and impractical to rebuild.
The new “best practice” is to create a centralized service where the work flow is organized and instruments are closely aligned. In this type of design the work flow is much more efficient, and staff has fewer steps between tasks and can be much more expedient in processing specimens. Ultimately this increases turnaround times of critical test results for physicians and patients, and results in a better work environment for the staff. With the advances in technology, one person can do multiple tasks in one area using state-of-the-art instrumentation.
Another mechanism to provide efficiency and convenience for the patient is the new Control Center, located on the first floor close to high activity areas. The Control Center functions similar to an “air traffic control” room. It is staffed with a variety of people representing key functions within the hospital. The area is designed for maximum communication and collaboration among the teams.
There will be multiple computer screens that will provide large visual displays of the various activities and flow of resources—patients, staff and key equipment. Bottlenecks in processing and movement of patients through the care continuum will be readily apparent and the Control Center staff will be able to quickly resolve issues. This will allow us to be much more efficient as we’ll see problems before they occur. The computer monitors will show us bed status: full, vacant, ready for cleaning; patients scheduled and waiting for discharge; expected completion times for surgical procedures; ER patient flow status, etc.
What does this mean for patients? It means less waiting time, more convenience and more time for personal care. For example, the Control Center can monitor patient wait status to ensure no one waits too long for testing. The necessary alerts will be displayed to the staff so they can provide efficient service. If surgical cases are running late, staff will be able to more effectively plan so resources of the OR and other support areas will be efficiently utilized, including communication to other affected physicians, patients and families. We’ll know on a real-time basis if we’re not performing at optimum levels and what the barriers might be. This knowledge will allow us to take the necessary action—e.g., deploy additional resources such as staff or equipment, and return the hospital to optimum performance levels.
Patient-focused clinical flow…
We also looked at clinical flow, from the patient’s perspective. One of our major goals from the beginning has been patient-focused care, creating convenience and comfort for our patients. We have effectively eliminated unnecessary trips within the new hospital for both patients and staff, starting with pre-op registration and diagnostic testing before surgery.
In the new hospital once the patient is registered and accompanied to their suite, clinical staff will come to the room for laboratory and other portable diagnostic testing. The goal is to minimize the amount of travel and disruption for the patient. We are also putting more services at the bedside. Due to the new hospital design of all private inpatient rooms, which are larger than our current rooms, we will be able to deliver more therapies at the bedside. This is an improvement for both patients and staff.
Please email me if you have any questions about the internal layout of the new medical center, or feel free to leave a comment here. We welcome your input!
My name is Bryan Daylor, and I am Vice President of Ancillary and Support Services at Eden Medical Center. I’m also on the “user” team that has had significant input on the design of the new Sutter Medical Center Castro Valley. Those of us who head up different functional areas at Eden worked collaboratively with our respective teams (consisting of managers, supervisors, staff and physicians) to determine the best way to improve the delivery of patient care in the new hospital by implementing industry “Best Practices.”
Our focus is on patient safety and quality of care, efficient patient flow and effective use of skilled resources. This work was an important opportunity to design a building that supports the process of care and enhances the experience for patients and caregivers. We were challenged with the puzzle of creating work space and flow in a new building, but in the end we feel we have achieved an excellent design for the new hospital.
It’s noteworthy that the replacement hospital for Eden will serve as a prototype for “best practices” operating models to be deployed to other Sutter Health affiliates that are building new hospitals of similar size and scope.
In the beginning…
When our user teams initially convened, the project size and scope had already been defined. We were challenged to look at how we do things today, and then be creative in how we could design this building to improve they way we provide care in the future. Some of the key goals of these teams were to look at quality and safety of care, efficiency for providers and an enhanced experience for the patient. All of these concepts had to be balanced with ways to drive down the operational cost of the hospital—hence efficiency! We looked at things like distances traveled by providers, adjacency of departments and services that work together, etc.
Acting as stewards of already-scarce resources, we decided that the hospital building would be designed for predominately clinical and direct patient care services, while almost all administrative functions would be housed in the adjoining medical office building. Hospital space costs more than twice that of regular medical office space to build and operate. So, our goal was to maximize clinical areas within the hospital and minimize the administrative functions. With the convenience of the connecting medical office building, placing the administrative services there helped us meet our budget goals without compromising the project or the future operations of the organization.
We deployed twelve different teams representing the various functional areas of the hospital, each looking at their role along the patient continuum of care and planning the layout of the hospital to support the care process. The user group contributed a wealth of knowledge that was invaluable to the development of the design of functional spaces for patient care.
Staff from all functional areas, including nursing, interventional services (surgery), sterile processing, radiology and imaging, women’s health, emergency and trauma, cardio-diagnostic testing, therapeutics, pharmacy, laboratory, and support services such as plant operations, facilities, food service, housekeeping and shipping & receiving, worked on the design of their respective units and then determined which services fit together. Efficient processing, and patient flow and experience, were key factors considered in these collaborative design sessions. Physicians from the emergency department, surgery, medicine, obstetrics and radiology also participated in the design discussions to ensure the efficiency of their part of the care process.
We worked with architects from The Devenney Group on the rough design of these areas, examining the most effective alternatives for organizing these services with consideration of services that are complementary to one another. The teams worked through several iterations of plans, building on the previous ideas and concepts from team members. The architects revised these layouts several times in draft form before a final schematic design was reached. This collaborative approach brought together years of healthcare delivery experience, as well as years of hospital and operational design experience to result in an efficient and aesthetically pleasing design that met Sutter Health’s project and budget goals.
The management team and physicians are proud of the work they have done and are excited to be a part of building the health care services of the future. Please feel free to comment here, or email me if you have any questions about the internal layout of the new medical center.
The new year brings renewed energy and focus on our project, as we move toward completing the entitlements to begin construction of the Sutter Medical Center Castro Valley hospital. The first major step in that process is the completion of the Environmental Impact Report. In December 2008, the Alameda County Planning Commission filed the Draft Environmental Impact Report (DEIR), and it is now available for inspection and comment.
As a reminder, the second public hearing on the DEIR is scheduled for tonight, Monday, January 5, 2009, at 6:00 p.m., in the Public Hearing Room of the Alameda County Planning Commission, 224 West Winton Avenue, in Hayward.
Of course, this isn’t the only opportunity to comment. The County can provide you with copies of the DEIR, or you can view them here, and you can send correspondence to the County directly in response to the DEIR. All of these links are provided here for your convenience.
In the meantime, we continue to grow our online network to keep our communities informed about our progress. We are still in the early stages, and we expect to continue to develop our online communities over the next several years through the construction period. Look for us on Facebook, LinkedIn, Twitter, FriendFeed and other popular sites, linked from the icons in the right sidebar.
You can also connect to us through your own social media networks. Contact our Social Media Team to let us know the URL (Web address) for your business, neighborhood or other social network where it might be appropriate for us to comment and discuss the new hospital with your online community.
Here’s to a healthy New Year!
Cassandra Phelps Clark
Project Communications Director
One of the most important elements we’re trying to take into account in designing the new Sutter Medical Center Castro Valley hospital is the experience patients and their loved ones want from their hospital stays, and the positive experience employees want from their work environment. There are a number of outcomes the design team is working to accomplish, innovation being an underlying theme.
First of all, gone are the days of patients sharing a hospital room with a complete stranger. Our new building features all private patient rooms with adjoining zones of space designed for the patient, the caregiver and a family or guest zone.
We’re even bringing design innovation to patient room doors, making them wider than standard to allow for safe assisted ambulation. And no more squeezing in to tiny patient bathrooms; sliding doors will be used for easy access.
Ceiling mounted bed lifts are being built into a number of patient rooms. These lifts use remote controls to lift patients on to gurneys or into wheel chairs. Talk about avoiding back strain! Not to mention patient falls. Portable bed lifts will also be widely available.
The power of natural light in promoting a healing experience has been well documented, so our design team has incorporated the use of natural interior light wherever possible. Sound absorbing materials are also being incorporated into the building design to promote a natural, calm and therapeutic setting. And all bedsides will be equipped with flat screen TVs and a full array of cable stations.
We’re implementing cool new technologies to make life easier for everyone as well.
While the lobby will have the typical staffed patient registration desk, we’ll also have walk-up kiosks for patients who are comfortable checking themselves in (think airport terminals). And visitors will be able to use the same HIPPA-compliant systems to locate their family and friends who’ve been admitted.
Most of us have sat long hours in waiting rooms sifting through magazines. At the new hospital we’ll have cool kiosks with WIFI access in patient rooms so you can be productive while your loved ones are getting the care they need.
Visitors (and staff) will have separate elevators and corridors to improve the visitor experience through a “front of the house” versus “back of the house” experience.
A number of other innovations will give the hospital staff greater functional improvements. Sutter Health will be rolling out a system called Vocera, a wireless, hands-free voice communication device, which allows key patient information that can be pushed out to the care giver to increase patient safety and improve response time, and dramatically reduces overhead noise by essentially eliminating overhead paging.
Electronic Medical Records (EMR) will be installed, as well as an automated “command center” to coordinate staffing, patient admissions, placement and discharge, patient flow and room turnover. The command center will also track patients and resources, manage process flow bottlenecks and maximize organizational efficiency.
The Universal Care Unit (UCU) is a one of the exciting innovations—an all-in-one patient care room. Whether the patient has to go to a post anesthesia care unit, surgical pre-op care, recovery, injections or short-term observation, the UCU can serve all of these patient functions. It can be used during an ER (emergency room) overflow when all inpatient beds are full. And in a large-scale disaster scenario, the UCU may also help to meet surge capacity needs. This will be a high activity area where patients who are in this unit will have actions being taken to improve and expedite their care process with the intent of improving outcomes and reducing the length of stay.
If you have any questions for the project team or want to comment about these exciting new hospital innovations, please click on the title of this post, and you’ll see a comment box (or it should appear below, if you’re just reading this one post). We really appreciate your feedback and suggestions…and, on behalf of our entire team, we wish you and your loved ones a healthy, safe and Happy Thanksgiving!